新生儿窒息气管插管复苏术的应用解剖

目的 为新生窒息复苏术提供应用解剖学基础。 方法 新生儿尸体32具，测身长及上部量（从头顶至耻骨联合上缘）；将标本头颈部正中矢状切开，暴露喉、气管及支气管，观察测量喉形态、软骨倾斜度；将头部置气管插管体位，测量自口腔和鼻腔至声门的长度、声门至气管杈的长度及气管内径。结果 （1）新生儿身长（50.87±2.02）cm，上部量（33.81±1.06）cm，与总体均数相比无显著性差异；（2）喉口平面与声带平面形成向后开放的角，角度为（46.82±1.58）°，与成人差别较大；（3）上中切牙至声门长（5.95±　0.51）cm，鼻前孔至声门长（7.06±0.47）cm，声门至气管杈长（4.94±0.74）cm，与身长及上部量呈直线相关；（4）气管起始端横径为（0.50±0.12）cm，矢状径为（0.38±0.04）cm，气管末端横径为（0.49±0.14）cm，矢状径为（0.35±0.06）cm，始、末端管径无明显差别。 结论　（1）新生儿插管前可以其身长或上部量为依据估算插管长度，插入不能过深，自口腔插管长度约7~9cm，自鼻腔插管长度约8 ~10 cm，管径以0.25~0.40 cm为宜；（2）选择喉镜时采用直镜片效果好，插入时要充分注意喉口平面与声带平面的锐角。

Applied Anatomy on the resuscitation of neonatal asphyxia

Objective　To provide anatomic basis for neonatal asphyxia resuscitation. Methods: 32 neonatal cadavers were used to measure about the body length, the upper part length(from corona capitis to upper border of pubic symphysis). And then, a median sagittal cut on the bodies were performed for exposing and observing of larynx, trachea and bronchus, involving the shape and position of larynx, and the slope degree of laryngeal cartilages. At the position of tracheal intubation, the lengths from oral cavity, and nasal cavity to glottis vera, from glottis vera to bifurcation of trachea, and the inner diameter of trachea were measured and analyzed.   Results (1) The body length of neonates was about (50.87±2.02）cm, the upper part length about （33.81±1.06）cm, and there were no significant difference among different cadavers. (2) The angle between aperture of larynx and vocal cords was about （46.82±1.58）°, and opened posteriorly, with an obvious difference compared to that of the adults.  (3)The length from upper incisors to the glottis was （5.95±0.51）cm, from the anterior naris to the glottis （7.06±0.47）cm, and from the glottis to the bifurcation of trachea（4.94±0.74）cm, respectively, which appeared a linear correlation with the lengths of the body and the upper part. (4) The proximal tracheal diameters and sagittal diameter were （0.50±0.12）cm and (0.38± 0.04）cm, while the distal tracheal diameter and sagittal diameter（0.49±0.14）cm and (0.35±0.06）cm, respectively, without significant difference between them.   Conclusions    According to the body length or the upper part length of the neonates, the tube length can be estimated before the intubation. For the neonates, the insertion depth has to be considered carefully, with the oral tube length about 7~9cm, the nasal tube length about 8~10cm, and diameter about 0.25~0.40cm. (2) For the neonates, laryngoscope with direct lens should be selected, and the full attention should be paid to the acute angle between the aperture of larynx and vocal cords during the trachea intubation.